Provider Demographics
NPI:1871531434
Name:PATURU, PRASAD VR (MD)
Entity type:Individual
Prefix:DR
First Name:PRASAD
Middle Name:VR
Last Name:PATURU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 N JOSEY LN STE 202
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4637
Mailing Address - Country:US
Mailing Address - Phone:972-443-9900
Mailing Address - Fax:972-443-9908
Practice Address - Street 1:4325 N JOSEY LN STE 202
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4637
Practice Address - Country:US
Practice Address - Phone:972-443-9900
Practice Address - Fax:972-443-9908
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0991207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183440001Medicaid
TX183440001Medicaid